R4 Clinical Soapbox with Dr. Philip Mudd

A Case: A middle aged male shows up at 8 AM with sore throat, subjective fevers, and URI symptoms. He had a strep swap performed which was negative and was treated symptomatically for URI. He returns 5 days later with persistent symptoms, body aches. Again, he has a relatively benign exam with mild oropharyngeal erythema without tonsillar edema, exudate, unchanged from before.

On the second visit the patient was tested for HIV and found to be positive. He was likely in the acute viral phase during both presentations.

CLINICOPATHOLOGIC Case Conference with Dr. Harrison vs Dr. Roche

The case: middle aged male with PMH of alcoholic cirrhosis with esophageal varices s/p banding and TIPS procedure who presents for left upper abdominal pain which is worse with coughing. He also complains of distention, nausea. On exam he demonstrates jaundice, mild wheezing, abdomen is non-tender to palpation with distention but no obvious fluid wave. Additional pertinent findings include: spider angiomata, no asterixis.

Nonsurgical TIPS complications to consider in the acute period just after the procedure:

Hepatic encephalopathy

Rapid progression of right heart failure

Worsening hepatic failure

SBP is a dangerous diagnosis so even if the tap is not a slam dunk for SBP, if your clinical suspicion is high it is not unreasonable to admit for observation and serial examinations while awaiting results of the culture.

Exposed pulp should be covered to prevent infection/pain (our dental carts include calcium hydroxide paste for this purpose) - this temporizing measure should be followed with rapid dental follow up for definitive treatment

Taming the SRU

SRU (pronounced "shrew") = Shock Resuscitation Unit

Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.

SRU (pronounced "shrew") = Shock Resuscitation Unit

Training in, and managing, the SRU is one of the crown jewels of our residency. It is where the sickest of the sick patients are found in our ED. It is a crucible, a test of knowledge and strength, and a true manifestation of the tripartite mission of our department: Leadership, Excellence, and Opportunity.